Health Connections - Women`s Health Specialists

Urinary
incontinence
Dr. James Vining discusses
pelvic health conditions and
treatment options
By Mara Knaub
Photos by Craig Fry
D
o you leak urine unexpectedly when you’re
physically active or when you sneeze, cough or
laugh?
Or do you feel a heaviness in your pelvic area, or a sense
of a mass bulging in your vagina?
If so, you are not alone.
These symptoms could be a sign of stress urinary
incontinence or pelvic organ prolapse, conditions that
affect millions of women worldwide.
And it’s a condition that women don’t
says Dr. James Vining, an OB/GYN
Women’s Health Specialists in Yuma.
all aspects of pelvic health, “a subject
me,” he said.
have to live with,
who practices at
He specializes in
near and dear to
Vining, who has been practicing in Yuma for 32 years,
recently discussed urinary incontinence and pelvic organ
prolapse at a Yuma Regional Medical Center Silver Care
program. He shared information on minimally invasive
procedures that can treat these conditions.
One in three woman suffer from urinary incontinence,
yet less than half seek treatment.
“They’re embarrassed. They feel ashamed. They’re
unaware that it’s treatable. They think it’s due to aging
and there’s nothing they can do,” Vining said.
“They’re great at adapting, going to the bathroom
frequently. She truly lives life going around knowing
where every bathroom is.”
But Vining believes incontinence is not something that
a woman should “adapt” to.
“As we get older, quality of life becomes important. As
we get older a lot of things we put up with because we
think it’s part of aging, but a lot of things we don’t have
to put up with,” he said.
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Health Connections
Urinary incontinence
There are three types of common bladder leakage:
urgent, stress and a mixture of the two. With urgent
incontinence, a women feels a strong, sudden need
to urinate. Stress incontinence is involuntary leakage
caused by physical movement, such as coughing, sneezing
and laughing.
In the case of mixed types of incontinence, the doctor
determines which one is more prevalent before deciding
on a treatment.
The potential risk factors for developing incontinence
include age, pregnancy, obesity, vaginal delivery,
hysterectomy, diet, family history and other medical
conditions.
Treatment could include medication, diet changes,
bladder retraining, Kegel exercises, biofeedback,
electrical stimulation or surgery.
The nonsurgical options include Kegel exercises and
training of the pelvic floor muscles.
“As you get older, it’s difficult to keep tone and you lose
muscle bulk. Like all muscle training, we could redevelop
those muscles,” Vining said.
“When the pelvic floor muscles are strong, they are able
to hold the urethra in place (so leakage does not occur),”
Vining explained.
“It’s kind of like standing on a hose on cement versus
sand. There’s a kinking and a suppression that occurs.
When the pelvic floor muscles are weak, the urethra
leaks urine.”
Medicine is only available for the “urgent” type of
incontinence. Jeannie McFarland, a certified continence
care nurse, explained that a neurologically controlled
muscle inside the bladder spasms when it’s time to
urinate. The medicine works by “quieting” the spasm.
March/April 2013
Side effects include dry eyes and mouth.
A surgical option is the minimally invasive mesh sling
procedure, which involves a small incision in the vagina,
abdomen or where the top of the thigh meets the pelvic
area.
“The sling forms a cradle or hammock of support. It
recreates that suppression. It will reestablish the two
mechanics — kink and suppression — it had before,”
Vining said.
The procedure is 90-95 percent effective. The patient is
advised to restrain from heavy lifting and intercourse for
four weeks. She can resume daily activities in two weeks.
The procedure has the same risks associated with any
surgery, such as pain, discomfort, inflammation and
scar tissue. Two percent experience mesh erosion, but “if
properly placed, it is less than
1 percent,” Vining said.
Some might develop a hole
between the organs or an
allergic reaction. “I’ve done
hundreds of these and I
haven’t seen that,” he noted.
Although this procedure
is very successful, “it’s not
perfect,” he added, noting that
the “return rate is small, less
than 5 percent.”
Pelvic Organ
Prolapse
Have you ever heard of a
“dropped bladder” or “fallen
uterus”? It refers to pelvic
organ prolapse, in which the
bladder, uterus or rectum
drop into the vagina.
The patient might feel a bulge or a lump in the vagina
or she might feel a pulling in the groin area. Symptoms
could include vaginal pain, chronic constipation and
painful intercourse.
Among the risk factors are pregnancy, childbirth,
menopause, previous surgery, obesity or family history.
Seventy percent of women with a prolapse will also
develop recurring urinary tract infection.
If the case is mild, a woman might opt for a nonsurgical
treatment, such as Kegel exercises or pessary devices,
March/April 2013
which are removable cubes placed in the vagina. A
device will support the areas of pelvic organ prolapse.
It’s removed occasionally so it can be cleaned and to let
tissue rest before being replaced.
Some women prefer these options over surgery, Vining
said.
Surgical options include reconstructive surgery to “put
everything together again.” But this has a 30 percent
failure rate over five years, Vining said.
A more successful procedure is the transvaginal mesh
repair, which has an 8 percent failure rate. Vining uses
the minimally invasive Elevate prolapse repair system,
which has a faster recovery and minimal pain. Mesh is
inserted through a small incision and seared in place. It
has a 91-96 percent success rate, Vining said.
Patients go home the day after the procedure and
usually only require overnight pain
medication.
“There’s a rapid return to activity, with
minimal discomfort,” he said.
However, Vining noted, some women
are leery of using
mesh
procedures
Dr. James Vining
following an FDA
from Women’s
advisory.
Health Specialists
talks to a group of
women about stress
urinary incontinence
and pelvic organ
prolapse during a
presentation at the
YRMC Corporate
Center.
“There’s an urban
legend out there
that
the
FDA
(Food and Drug
Admin istration)
pulled it from the
market. That’s not
true,” Vining said.
Actua lly
he
explained, the FDA
issued a notification
of complications in 2008. Vining insists
those complications are the same as any
surgical procedure.
“There are 600,000 of these surgeries each year in
the United States, and there have been 284 reports of
complications,” he said.
He suggests women suffering from incontinence or
prolapse to educate themselves by reading peer-reviewed
websites such as WebMD and to talk to their doctor or
specialist.
For more information or to make an appointment
for bladder control testing, call the Women’s Health
Specialists at (928) 783-3050. 
Health Connections
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